Part-Time Claims Consultant

Software Guidance & Assistance, Inc., (SGA), is searching for a Part-Time Claims Consultant for a CONTRACT assignment with one of our premier Insurance Services clients. This position is fully remote.

The Claims Consultant evaluates individual disability income insurance claims and makes claims decisions in accordance with policy provisions and within prescribed time service standards. In this role, the Claims Consultant is responsible for exercising independent judgment, demonstrating critical thinking skills, exemplary customer service as well as effective inventory management skills

Responsibilities :

• Independently manages an assigned caseload of, and makes claims decisions on, moderately complex claims which consists of pending, ongoing, disputed and appeal reviews.
• Provides timely, balanced, and accurate claims reviews, documentation, and decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations.
• Provides timely and detailed written communication throughout the claim evaluation outlining comprehensive claim status and/or claim determinations.
• Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during claim evaluations.
• Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members throughout the claim evaluation.
• Compiles file documentation and correspondence requiring extensive policy analysis and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available.
• Collaborates with both external and internal resources, such as physicians, attorneys, vocational consultants, and CPAs to gather data such as medical/occupational information to ensure claim decisions are well-reasoned and thorough.
• Identifies, clarifies, and reconciles inconsistencies when gathering information during claim evaluations and collaborates with underwriting and Fraud Waste and Abuse resources, as needed.
• Identifies offsets and proficiently calculates monthly benefits, to include COLA, Social Security Offsets, Residual Disability, and other non-routine payments.
• Provides timely and detailed written communication during the claim evaluation, which outlines and supports the status of the evaluation and/or claim determination.
• Addresses and resolves escalated customer complaints in a timely and thorough manner, including drafting written responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to litigation support partners.
• May represent the firm at depositions and trials.

Required Skills :

• Prior experience with independent judgement and decision making.
• Critical thinking and analysis skills when reviewing information.
• Creative problem-solving abilities when working in grey areas and the ability to think outside the box.
• Excellent interpersonal and communication skills in both verbal and written form.
• Excellent customer service skills proven through internal and external customer interactions.
• Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively.
• Organizational and time management skills.
• Ability to effectively manage multiple systems and technology sources.
• 3+ years of IDI or LTD insurance claims experience.

Preferred Skills :

• Bachelor's degree
• 5+ years IDI experience

SGA is a technology and resource solutions provider driven to stand out. We are a women-owned business. Our mission: to solve big IT problems with a more personal, boutique approach. Each year, we match consultants like you to more than 1,000 engagements. When we say let's work better together, we mean it. You'll join a diverse team built on these core values: customer service, employee development, and quality and integrity in everything we do. Be yourself, love what you do and find your passion at work. Please find us at .

SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities. Please visit our company to request an accommodation or assistance regarding our policy.